Palisaded neutrophilic and granulomatous dermatitis

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Palisaded neutrophilic and granulomatous dermatitis
Specialty Dermatology

Palisaded neutrophilic and granulomatous dermaititis (PNGS) is usually associated with a well-defined connective tissue disease, lupus erythematosus or rheumatoid arthritis most commonly, and often presents with eroded or ulcerated symmetrically distributed umbilicated papules or nodules on the elbows. [1] [2]

Contents

Signs and symptoms

Typical clinical manifestations include erythematous to violaceous plaques that are symmetrically distributed, skin-colored linear cords involving the lateral trunks, and skin-colored or erythematous papules with crusting, perforation, or umbilication. [3]

Causes

Palisaded neutrophilic and granulomatous dermaititis is associated with subacute bacterial endocarditis, [4] ledipasvir/sofosbuvir, [5] allopurinol, [6] Hodgkin’s and non-Hodgkin’s lymphoma, [4] chronic myelomonocytic leukemia, [7] ulcerative colitis, [8] Takayasu arteritis, [4] systemic vasculitis, [8] systemic lupus erythematosus (SLE), [9] sarcoidosis, [10] rheumatoid arthritis, [11] eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome), [8] chronic uveitis, [10] and adult-onset still’s disease. [4]

Treatment

The underlying illness is the main focus of PNGD treatment. Up to 20% of patients may experience spontaneous resolution of the lesions. Topical corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs), dapsone, prednisone, colchicine, oral tacrolimus, and TNF inhibitors are among the available treatment options. [3]

See also

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References

  1. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 181. ISBN   0-7216-2921-0.
  2. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  3. 1 2 Zabihi-pour, Dorsa; Bahrani, Bahar; Assaad, Dalal; Yeung, Jensen (2021). "Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report". SAGE Open Medical Case Reports. SAGE Publications. 9: 2050313X2097956. doi:10.1177/2050313x20979560. ISSN   2050-313X. PMC   7882758 . PMID   33628445.
  4. 1 2 3 4 Deen, Jacqueline; Banney, Leith; Perry-Keene, Joanna (December 11, 2017). "Palisading neutrophilic and granulomatous dermatitis as a presentation of Hodgkin lymphoma: A case and review". Journal of Cutaneous Pathology. Wiley. 45 (2): 167–170. doi:10.1111/cup.13076. ISSN   0303-6987. PMID   29226345. S2CID   43221453.
  5. ↑ Shenk, Mary Elizabeth Reed; Ken, Kimberly Marie; Braudis, Kara; Fernandez, Kristen Heins (2018). "Palisaded neutrophilic and granulomatous dermatitis associated with ledipasvir/sofosbuvir". JAAD Case Reports. Elsevier BV. 4 (8): 808–810. doi:10.1016/j.jdcr.2018.06.025. ISSN   2352-5126. PMC   6141673 . PMID   30246134.
  6. ↑ Gordon, Katherine; Miteva, Maria; Torchia, Daniele; Romanelli, Paolo (January 18, 2012). "Allopurinol-induced palisaded neutrophilic and granulomatous dermatitis". Cutaneous and Ocular Toxicology. Informa UK Limited. 31 (4): 338–340. doi:10.3109/15569527.2011.647180. ISSN   1556-9527. PMID   22250812. S2CID   207619806.
  7. ↑ Kyriakou, Aikaterini; Patsatsi, Aikaterini; Papadopoulos, Vassilios; Kioumi, Anna; Efstratiou, Ioannis; Lazaridou, Elizabeth (February 20, 2019). "A case of palisaded neutrophilic granulomatous dermatitis with subsequent development of chronic myelomonocytic leukemia". Clinical Case Reports. Wiley. 7 (4): 695–698. doi:10.1002/ccr3.2072. ISSN   2050-0904. PMC   6452460 . PMID   30997066.
  8. 1 2 3 Coutinho, Inês; Pereira, Neide; Gouveia, Miguel; Cardoso, José Carlos; Tellechea, Oscar (2015). "Interstitial Granulomatous Dermatitis". The American Journal of Dermatopathology. Ovid Technologies (Wolters Kluwer Health). 37 (8): 614–619. doi:10.1097/dad.0000000000000288. ISSN   0193-1091. PMID   25830722. S2CID   8324194.
  9. ↑ Terai, S; Ueda-Hayakawa, I; Nguyen, C T H; Ly, N T M; Yamazaki, F; Kambe, N; Son, Y; Okamoto, H (October 30, 2018). "Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works". Lupus. SAGE Publications. 27 (14): 2220–2227. doi:10.1177/0961203318809892. ISSN   0961-2033. PMID   30376790. S2CID   53108791.
  10. 1 2 Kwon, Eun J.; Hivnor, Chad M.; Yan, Albert C.; Forbes, Brian; Elenitsas, Rosalie; Albert, Dan; Pawel, Bruce; Honig, Paul; Pessler, Frank (2007). "Interstitial Granulomatous Lesions as Part of the Spectrum of Presenting Cutaneous Signs in Pediatric Sarcoidosis". Pediatric Dermatology. Wiley. 24 (5): 517–524. doi:10.1111/j.1525-1470.2007.00508.x. ISSN   0736-8046. PMID   17958801. S2CID   30684569.
  11. ↑ Sangueza, Omar P.; Caudell, Misty D.; Mengesha, Yebabe M.; Davis, Loretta S.; Barnes, Cheryl J.; Griffin, Julia E.; Fleischer, Alan B.; Jorizzo, Joseph L. (2002). "Palisaded neutrophilic granulomatous dermatitis in rheumatoid arthritis". Journal of the American Academy of Dermatology. Elsevier BV. 47 (2): 251–257. doi:10.1067/mjd.2002.124620. ISSN   0190-9622. PMID   12140472.

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